Telehealth State of the States

September 15  

By Sarah-Lloyd Stevenson

In the Midwest and across the country, state governments are recognizing that telehealth is a viable and affordable option for providing healthcare services to patients and their communities. In recent years, nearly every state has taken a step toward improving the coverage or reimbursement of telehealth. However, policies look very different from one state to the next, and recent progress has resulted in a patchwork of laws, regulations, and policies that can be difficult for providers and patients to understand as telehealth grows in popularity as a modality of care.

To better comprehend the state of telehealth policies across the United States, the American Telemedicine Association (ATA), in partnership with Faegre Baker Daniels, took a deep dive into the coverage and reimbursement of telehealth in all 50 states and Washington, D.C. What we found is that telehealth access is indeed expanding, though not at a consistent rate or by a predictable path. We’ve discovered that recent developments at the state level, coupled with the growing awareness of telehealth in the nation’s capital, gives telehealth advocates strong reason for optimism about the future of the industry.

We have outlined some of the key findings from the ATA’s recently released “2019 State of the States Report: Coverage and Reimbursement” as well as the policy implications of telehealth’s growth over the last two years. Since 2017 – the last time the ATA released a comprehensive report on state telehealth policies – 40 states and the district have adopted substantive policies or received awards that improved coverage and reimbursement of telehealth. In an extensive analysis of these policies, we found that private payer parity and removing restrictions on patient setting were two of the most common issues taken up by states. The findings also detail state rules around eligible technologies and provider types, as well as new innovation models. 

Key Findings From the ATA’s 2019 Report

  • 36 states and the district have parity policies for private payer coverage while only 21 states and the district have coverage parity policies in Medicaid
  • 28 states have Medicaid payment parity policies while only 16 states mandate payment parity for private payers
  • Only one state – Alabama – recognizes only physicians as eligible providers
  • The majority of states have no restrictions around eligible provider types and 10 states have authorized six or more types of providers to treat patients through telehealth
  • Only 16 states limit telehealth to synchronous technologies while most of the country recognizes the benefits of remote patient monitoring (RPM) and store and forward (S&F)
    • 22 states and the district cover RPM.
    • 29 states and the district cover S&F.
    • No two states’ policies are identical. The report details how the treatment of RPM and S&F is complex and how restrictions differ state by state.

For providers, patients, and policymakers interested in understanding or expanding the use of telehealth in any state or collection of states, data on state policies is invaluable. It is important to note that even when two states seem to have similar policies around coverage and reimbursement, there may still be contradictory rules in place that impact the provision of services. Several states have additional provider or originating site (where the patient is located) restrictions that further complicate care delivery for telehealth providers. For example, Indiana requires an in-person attendant to be with the patient during the time of a synchronous telehealth encounter, and while Michigan requires a similar facilitator to be with the patient, it also has rules on the books that telehealth services should primarily be used when travel is prohibitive for the patient or when there is an imminent health risk. Locally, Minnesota may require a healthcare provider to be present to help facilitate the delivery of telehealth services provided in a patient’s home.

The complex patchwork of policies and laws across the country, including differing rules even in neighboring states, makes telehealth uptake complicated for a provider that may not have a grasp on local laws. However, getting a handle on policies can empower providers and vendors to capitalize on the use of these increasingly popular technologies.

The biggest takeaway from this year’s research is that the state of telehealth is strong. Even though policies may seem complex and even contradictory at times, progress continues to be made. We can be certain that state laws and restrictions will continue to evolve as states work to identify the barriers to care and agree on new ways to cover and reimburse a growing number of telehealth services. For those who want to see telehealth expand, understanding individual state rules is essential to targeting specific policy changes and restrictions to remove in every state capital across the country.

Proponents should be encouraged by the opportunity present at the state and the federal levels for telehealth policy advancement in the coming months and years. The bottom line is that, while the policies are different in each state, there is a lot of legal authority in every state for telehealth adoption. Policies, of course, do not happen in a vacuum, and often federal reimbursement policies set the tone for the entire country. While recent research has focused on policies at the state level, it is important to note that Congress and the Trump administration have advanced bipartisan policies to promote the use of telehealth. Specifically, the Bipartisan Budget Act of 2018 included provisions to support telehealth in Medicare by:

  • Expanding the use of telestroke
  • Allowing telehealth in Medicare Advantage plans
  • Removing telehealth restrictions for patients with end-stage renal disease
  • Enabling accountable care organizations (ACOs) to use a telehealth waiver

Additionally, the Federal Communications Commission (FCC) has launched a telehealth pilot, the Department of Veterans Affairs (VA) has expanded access to telehealth for veterans, and broadband and technology access has been a funding priority for federal policymakers in recent years.

The conversation about how to expand telehealth access is happening across the country and in our nation’s capital. Advocates should be optimistic about where new policies will drive telehealth adoption and how more patients will have access to these technologies soon. While the differences in the state-by-state laws may seem daunting, momentum gained in the last few years seems likely to continue in the coming months, providing more opportunities at the state and federal levels for providers and patients to harness these tools that proponents believe will improve access, decrease costs, and promote quality healthcare.

For questions or more information, please contact Sarah-Lloyd Stevenson.

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